Blood work on radiation and Lupron

[Mgtd]

I am sure this has probably been discussed before but I could not find an answer. How long after initial radiation should you wait to get a valid PSA test?

Background

Started Lupron 6 weeks prior to radiation and Casodex one week before that to reduce the spike of testosterone. Next week will be my last of 20 radiation treatments.

Urology physician assistant (PA) gave me a PSA blood lab slip to do prior to my next Lupron shot which is about 15 days after completing radiation. She said it was standard office protocol to do PSA test prior to Lupron shot. This will be my last visit to this office and will then transition to the care of a medical oncologist in the future.

Will getting a PSA test that soon give a valid reading or should I skip it and wait for how long after radiation? My follow up radiation appointment with the medical oncologist is 12 weeks after radiation and I have a lab slip for a CBC, comprehensive Metabolic panel and a PSA total screen to be done prior.

This new PA at the urologist office was the one that gave me a 3 month Lupron when I had requested a 1 month shot so I have a very low confidence level in her answers and directions. Unable to reach urologist.

Thanks for your thoughts.

[Don_1213]

Since the urologist's office said they're turning you over to a medical oncologist - find the best one you possibly can (usually in my experience, one associated with a major medical school hospital who does research and teaches and has some patients) - and ask them.

As far as having the PSA test - why wouldn't you want to have it? A month out from radiation the number may still be a bit high since it can take radiation up to a year to do it's magic, but the ADT should be pushing your testosterone down and that should push down your PSA.

I'm a believer in the more PSA tests the better. I have 3 MDs who order them for me - so I have roughly one every 6-8 weeks. I believe in keeping an eye on what's going on.

Do check if the script for the PSA includes a testosterone test - the PSA is sort of worthless without knowing where your T is. I'd suspect since you're into ADT for what looks like about 3-4 months it should be near castrate levels (below 20). I'd also suggest NOT doing the ultra-sensitive PSA test - with the treatment you've had some residual PSA is absolutely normal.. so the ultra-sensitive test is just going to make you worry more.

The only reasons I can see for not having the PSA tests are:

- You have to pay out of pocket for them

- You're an obsessive personality who will go bonkers waiting for the results. ALL of us are a bit like that - but if you use the right lab - you should be able to get same-day results (Quest in NJ does that provided you're not doing a complex blood analysis - then it takes longer since they send that to Maryland for some reason.)

[Tall_Allen]

Skip the PSA - get a testosterone instead. That will tell you if the Lupron is working (it usually is).

Get your first PSA 3 months after completing radiation. If you are still on Lupron, it will be undetectable (<0.1) on a PSA test. PSA will rise after you stop Lupron and your T level comes back, but it should fall over time

[Hidden in reply to Tall_Allen]

Im curious to see what RT will do to my PSA.

I have standing orders for monthly blood tests due to Zytiga, includes PSA. Been <0.1 since first month of ADT.

Last PSA (<0.1) was 1 hour before 1st RT. Just did labs this morning, end of week 5 RT.

Next one about 3 to 4 weeks after RT complete.

[j-o-h-n]

Heed the advice of Mr. T_A............... But never Heed my advice...........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/17/2023 4:57 PM DST

[Mgtd]

Thanks for the assistance and info. My radiation oncologist ordered a testosterone about mid way through the radiation . It had dropped from 687 to <7 so we know the Lupron is working.

Based on your input I will pass on the PSA test at this point. Just one less needle jab and since Lupron is working we know it will be <1 till I stop the Lupron in three months/October. I am only getting 6 months of it unless that changes based on the new medical oncologist.

Enjoy your Father’s Day!

[GumpaD28]

Im reading about stopping the Lupron. Is this normal or do some continue with Lupron forever how long. Ive been getting the shot every 3mnths now for past year and haven't heard anything about ceasing it from my MO. Thank and Happy Father's Day to all ✌

[Mgtd in reply to GumpaD28]

Happy belated Father’s Day to you too.

Please keep in mind that I am NOT a doctor so what I am about to relay is my research into this subject and how I approached the issue. Without any other data on your specific case I will outline how I came to my conclusion.

The driving factor is the level of the cancer risk - Low, Intermediate and Unfavorable level. This varies by individual based on test results.

You then need to consider age, level of risk you are willing to accept and you feeling about various side effects of treatments and your current health issues as well as what remission/curative strategies your selected prior - radiation, surgery, etc. You may also need to consider some level of genetic testing based on your individual situation.

Remember there is no free lunch. Once you nailed all this down with your urologist and MO then comes the shared decision model of cost benefit analysis of Lupron and for how long.

Based on this you will probably need to decide between 4 to 6 months, 12 to 18 months , 24 to 36 months or forever until your cancer become hormone sensitive to Lupron and you need to switch to the next level of drugs.

I realize this a broad 50,000 foot view to your general question but you need to meet with your MO to begin this discussion.

Hope this helps.

[Mgtd in reply to GumpaD28]

Sorry after I wrote my reply I read your bio info. Sounds like you are on the journey of already changing hormone medication, etc. You may want to start a new thread so that people can better answer your questions about this process and how this journey unfolds.

Sorry I should have looked before I wrote my first reply.